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CORK Bibliography: Impaired Physicians

49 citations. 2003 to present

Prepared: September 2008

Angres DH; McGovern MP; Shaw MF; Rawal P. Psychiatric comorbidity and physicians with substance use disorders: A comparison between the 1980s and 1990s. Journal of Addictive Diseases 22(3): 79-87, 2003. (24 refs.)

The assessment and treatment of physicians with substance use disorders has been of considerable interest over the past twenty years. This study compares two cohorts-of addicted physicians treated at a single program. Data from 101 physicians treated during 1985 to 1987 were compared with 73 physicians treated from 1995 to 1997. Although the cohorts were similar on demographic, physician specialty, and drug of choice variables, psychiatric comorbidity was significantly more prevalent in the later sample.

Baldwin DC; Daugherty SR. Sleep deprivation and fatigue in residency training: Results of a national survey of first- and second-year residents. Sleep 27(2): 217-223, 2004. (54 refs.)

Study Objectives: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates. Design: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail. Measurements and Results: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors. Conclusions: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.

Bohigian GM; Bondurant R; Croughan J. The impaired and disruptive physician: The Missouri Physicians' Health Program - An update (1995-2002). Journal of Addictive Diseases 24(1): 13-23, 2005. (10 refs.)

Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical, diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The recovery rate in this study of 197 participants was 90 %. New concepts of the "Behaviorally Disruptive Physician" and the Joint Commission on the Accreditation of Health Care Organization requirements regulating physician impairment are also discussed.

Bonnet U; Harkener J; Scherbaum N. A case report of propofol dependence in a physician. Journal of Psychoactive Drugs 40(2): 215-217, 2008. (20 refs.)

Propofol is a widely used general anaesthetic with multisite mechanisms and especially ultrashort activation of certain central GABA-A receptors. Since its introduction into the market in the mid 1980s this is the seventh report on propofol dependence in the literature. The present case shows for the first time that craving for propofol can be quite intense and able to induce addictive behaviour.

Collins GB; McAllister MS; Jensen M; Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: Results of a survey. Anesthesia and Analgesia 101(5): 1457-1462, 2005. (18 refs.)

Substance abuse is a potentially lethal occupational hazard confronting anesthesiology residents. We present the results of a survey sent to all United States anesthesiology training programs regarding experience with and outcomes of chemically dependent residents from 1991 to 2001. The response rate was 66%. Eighty percent reported experience with impaired residents and 19% reported at least one pretreatment fatality. Despite this familiarity, few programs required pre-employment drug testing or used substance abuse screening tools during interviews. The majority of impaired residents attempted reentry into anesthesiology after treatment. Only 46% of these were successful in completion of anesthesiology residency. Eventually, 40% of residents who underwent treatment and returned to medical training entered another specialty. The mortality rate for the remaining anesthesiology residents was 9%. Long-term outcome was reported for 93% of all treated residents. Of these, 56% were successful in some specialty of medicine at the end of the survey period. We hypothesize that specialty change afforded substantial improvement in the overall success rate and avoided significant mortality. Redirection of rehabilitated residents into lower-risk specialties may allow a larger number to achieve successful medical careers.

Dyrbye LN; Thomas MR; Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. (review). Mayo Clinic Proceedings 80(12): 1613-1622, 2005. (171 refs.)

The goal of medical education Is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Farber NJ; Gilibert SG; Aboff BM; Collier VU; Weiner J; Boyer EG. Physicians' willingness to report impaired colleagues. Social Science & Medicine 61(8): 1772-1775, 2005. (10 refs.)

We surveyed physicians to determine what factors were associated with their reporting of impaired colleagues to Physician Health Programs (PHPs). We conducted a cross-sectional mail survey of 1000 randomly selected practicing physicians in the United States. A survey instrument asked the physicians whether they would report 10 hypothetical impaired colleagues to a PHP. The results show that a majority of the physicians would report physicians to PHPs, but were more likely to report hypothetical physicians involved in substance abuse than those who were emotionally or cognitively impaired (p < 0.001). Respondents who felt they had a societal obligation as opposed to an obligation to protect the rights of the individual (p = 0.006) were more likely to report hypothetical physicians. Those respondents who stated they knew of guidelines on reporting impaired physicians had more frequently reported impaired colleagues (p < 0.001). We conclude that physicians should be educated on the availability and functioning of PHPs and the ethical and legal obligations of assisting impaired colleagues.

Fawcett J. Heal thyself: Physicians must maintain their own mental and physical health to be in a position to help patients with theirs. Psychiatric Annals 34(10): 735, 2004. (0 refs.)

This is an introduction to this thematic issues that focuses upon issues of disabled physicians, including substance abuse and behavioral difficulties.

Firth-Cozens J. Doctors with difficulties: Why so few women? Postgraduate Medical Journal 84(992): 318-320, 2008. (35 refs.)

The National Clinical Assessment Service (NCAS), an NHS organisation that assesses doctors and dentists referred to them because of perceived difficulties, has produced a report describing data arising from its first 4 years, showing that male doctors were referred to the service considerably more often than female doctors. Despite women accounting for 42% of the general practitioner medical workforce and 37% of the medical hospital and community (H&C) workforce in 2004, only 13% of GPs and 20% of H&C NCAS referrals were women. When the H&C data were split into specialties, women were under-represented proportionally in all specialties. This paper offers a review of possible reasons for these gender differences and in doing so contributes to the debates concerning problems in performance and also the costs of employing a growing proportion of women doctors. Firstly, it hypothesises that the NCAS data may be nonrepresentative of similar agency data, but finds that in disciplinary organisations of various types around the world, men are consistently over- represented. Secondly, it suggests that perhaps men are referred to such agencies more often than women because their employers are more lenient on women. There is no evidence for this, and it requires primary research to investigate it further. Finally, it considers gender differences in the attributes, beyond technical skills, that underpin a good doctor - patient relationship and finds that, on these attributes, women usually excel over men. In addition, far fewer women are disciplined for addiction. The implications of this for education and rehabilitation are considered. It concludes that any analysis of the economic costs of employing a greater proportion of female doctors must take into account the higher costs of men's litigation, discipline and retraining.

Fowlie DG. Doctors' drinking and fitness to practice. Alcohol and Alcoholism 40(6): 483-484, 2005. (8 refs.)

This editorial focuses upon the efforts of CHITS (Clinicians' Health, Intervention, Treatment and Support) a confederation established in 2002 to bring together the work of the Sick Doctors Trust, the Dentists, Pharmacists and Veterinary Surgeons Health Support Programmes, the British Medical Association's Doctors for Doctors Initiative (now incorporating the National Counselling Service for Sick Doctors). It is extending its involvement with the Medical Council on Alcohol and with the Royal College of Psychiatrists Addiction Psychiatry Faculty. The group endorses the benefits of active intervention and emphasizes the importance of local links between Clinical Services, Occupational Health Services, Clinical Directorates, and Employing Authorities.

Galanter M; Dermatis H; Mansky P; McIntyre J; Perez-Fuentes G. Substance-abusing physicians: Monitoring and twelve-step-based treatment. American Journal on Addictions 16(2): 117-123, 2007. (31 refs.)

This study was designed to provide an independent evaluation of the oversight and rehabilitation of substance-impaired physicians. Records of 104 physicians who had completed their monitoring period by the New York State Committee on Physicians' Health were selected at random from CPH files. They had been followed for an average of 41.3 months. Practice characteristics and substance use before admission, as well as workplace monitoring, twelve-step attendance, urine toxicologies, and relapse incidence after admission are reported. Significant intercorrelations among these variables were ascertained by logistic regression. The utility of twelve-step-based rehabilitation as part of a treatment plan for sustaining abstinence and averting relapse is discussed.

Gastfriend DR. Physician substance abuse and recovery: What does it mean for physicians-and everyone else? (editorial). Journal of the American Medical Association 293(12): 1513-1515, 2005. (24 refs.)

Gold MS; Melker RJ; Dennis DM; Morey TE; Bajpai LK; Pomm R et al. Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis. Journal of Addictive Diseases 25(1): 15-21, 2006. (20 refs.)

We have proposed a novel hypothesis regarding the potential role of occupational or second-hand exposure in physician substance use, abuse, and addiction. While only 5.6% of licensed physicians in Florida are anesthesiologists, nearly 25% of physicians followed for substance abuse/dependence are anesthesiologists. When we sort by drug of choice, anesthesiologists have more opioid abuse and dependence than other physicians and appropriate controls. Abuse of one opioid, fentanyl, appears to be increasing and has been noted among the State of Florida's causes of opioid deaths. Fentanyl and sufentanyl are commonly administered highly potent opioid analgesics, as much as 80-800 times as potent as morphine. We have recent data from the State of Florida impaired physicians database, which has allowed us to categorize all fentanyl abusing and/or dependent physicians. Just knowing that a physician abuses fentanyl gives you a good clue as to their specialty; 75% are anesthesiologists! While drug abuse researchers, oncologists and others who handle drugs of abuse everyday, have no greater incidence of opioid abuse or dependence, anesthesiologists are at the top of every list. Can this be due to just access and stress? We have proposed an alternative hypothesis of second hand exposure. To test this hypothesis, we developed a sensitive LC/MS/MS assay to measure the intravenous anesthetic and analgesic agents, propofol and fentanyl in air. Not only did we detect propofol and fentanyl in cardiovascular surgery operating room air, we also found the highest concentrations were close to the patient's mouth where anesthesiologists work for hours. Like tobacco, second hand opioid exposure can sensitize and change the brain making abuse, dependence and behavioral disorders more likely. Thus environmental exposure and sensitization may be an important risk factor in physician addiction. Second hand exposure may affect treatment outcome and explain anesthesiologist's inability to return to work in the operating room. We are developing an animal model for second hand exposure and additional studies of the operating room and cardiac anesthesiologists are underway.

Handel DA; Raja A; Lindsell CJ. The use of sleep aids among Emergency Medicine residents: A web based survey. BMC Health Services Research 6(e136), 2006. (28 refs.)

Background: Sleepiness is a significant problem among residents due to chronic sleep deprivation. Recent studies have highlighted medical errors due to resident sleep deprivation. We hypothesized residents routinely use pharmacologic sleep aids to manage their sleep deprivation and reduce sleepiness. Methods: A web-based survey of US allopathic Emergency Medicine ( EM) residents was conducted during September 2004. All EM residency program directors were asked to invite their residents to participate. E-mail with reminders was used to solicit participation. Direct questions about use of alcohol and medications to facilitate sleep, and questions requesting details of sleep aids were included. Results: Of 3,971 EM residents, 602 (16%) replied to the survey. Respondents were 71% male, 78% white, and mean (SD) age was 30 ( 4) years, which is similar to the entire EM resident population reported by the ACGME. There were 32% 1st year, 32% 2nd year, 28% 3rd year, and 8% 4th year residents. The Epworth Sleepiness Scale (ESS) showed 38% of residents were excessively sleepy ( ESS 11 - 16) and 7% were severely sleepy (ESS> 16). 46% ( 95 CI 42% - 50%) regularly used alcohol, antihistamines, sleep adjuncts, benzodiazepines, or muscle relaxants to help them fall or stay asleep. Study limitations include low response and self-report. Conclusion: Even with a low response rate, sleep aid use among EM residents may be common. How this affects performance, well-being, and health remains unknown.

Harrison J. Doctors' health and fitness to practise: The need for a bespoke model of assessment. (review). Occupational Medicine (Oxford) 58(5): 323-327, 2008. (32 refs.)

Doctors' performance and fitness to practise are attracting increased attention. High profile cases have brought into question the assessment of fitness to practise and the monitoring of professional performance. In the UK, the chief medical adviser for England has proposed strengthening systems to improve the performance of doctors which include addressing problems of ill-health. The behaviour of the impaired physician, or the doctor-patient, presents unique challenges and a review of the various issues highlights the need to address how the medical profession and society deal with the occurrence of illness in doctors. Conditions such as mental ill-health and substance abuse may affect doctors' fitness to practise, but other conditions may also be relevant. This paper will discuss the occurrence of ill-health and the need for a bespoke model of assessment.

Hulse GK; O'Neil G; Arnold-Reed DE. Management of an opioid-impaired anaesthetist by implantable naltrexone. Journal of Substance Use 9(2): 86-90, 2004. (19 refs.)

Compared with the general population, physicians are at increased risk for abuse of prescription opioids. This use can interfere with work function and has potential negative implications for patient safety. The case example in this brief communication describes an opioid-dependent anaesthetist who, following 10 years of opioid abuse/dependency and a number of unsuccessful treatments, including oral naltrexone, and relapses, received a number of sequential naltrexone implants as part of his management. The case involved a close collaboration between the treating doctor, employer and the General Medical Council (GMC), with ongoing monitoring and follow-up, a GMC requirement of return to medical employment. This case study is used to illustrate that by sequential implant treatment blood levels of naltrexone can be maintained at levels required for antagonism of opioid-based drugs for significant periods of time. The GMC, employer and treating physician were able to monitor blood naltrexone levels, with the treating physician able to palpate the implant and thereby confirm that the previously opioid-dependent physician had remained on treatment. The authors conclude that with implantable naltrexone, opioid abstinence can virtually be guaranteed. Naltrexone implants therefore offer a level of protection not achieved with any previous treatment.

Jacobs WS; Repetto M; Vinson S; Pomm R; Gold MS. Random urine testing as an intervention for drug addiction. Psychiatric Annals 34(10): 781-784, 2004. (32 refs.)

Drug testing via urinalysis can serve as a useful tool in the identification of people with drug abuse or dependence and in the evaluation of the success of their treatment. Researchers have demonstrated that qualitative and quantitative urine testing detects higher rates of drug use than that detected by self-report. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), provides well-researched diagnostic standards for drug abuse and dependence, but the diagnosis of these conditions using its criteria lack a quantitative, external measure of drug use. Such an external measure also would be beneficial in the treatment phase of substance dependence and substance abuse, as both an incentive for patient compliance and an accurate measure of the treatment's success in procuring abstinence. In light of this, this article explains the importance of drug testing as a treatment component in substance abuse; describes common practices and procedures in urine drug screening; and discusses the positive role urine drug screening has played in the treatment of substance-abusing physicians.

Katsavdakis KA; Gabbard GO; Athey GI. Profiles of impaired health professionals. Bulletin of the Menninger Clinic 68(1): 60-72, 2004. (12 refs.)

There are numerous studies that describe the characteristics of impaired health professionals and the types of professional misconduct leading to licensing board action. These studies have two fundamental limitations. The first is the sampling procedure, and the second is that they typically do not examine health professionals who are currently in treatment. This study describes the problems that lead health professionals-comprising psychiatrists, nonpsychiatric physicians, psychologists and social workers-to seek treatment and the sources of referral for treatment. A total of 334 health professionals were studied who sought out an evaluation or treatment at The Menninger Clinic between 1985 and 2000. The findings indicated that the participants' therapist was the largest referral source and that the most commonly cited problems leading to referral were marital and emotional difficulties rather than substance abuse, boundary violations, or prescribing problems. Licensing and regulatory agencies can take proactive steps to identify professionals with social and emotional vulnerabilities who may be at greater risk for unethical and negligent behavior.

Kenna GA; Lewis DC. Risk factors for alcohol and other drug use by healthcare professionals. Substance Abuse Treatment, Prevention, and Policy 3(e-article 3), 2008. (46 refs.)

Background: Given the increasingly stressful environment due to manpower shortages in the healthcare system in general, substance induced impairment among some healthcare professions is anticipated to grow. Though recent studies suggest that the prevalence of substance abuse is no higher in healthcare professionals (HPs) than the general population, given the responsibility to the public, any impairment could place the public at increased risk for errors. Few studies have ever reported predictors or risk factors for alcohol and other drug use (AOD) across a sample of HPs. Methods: The study used a cross-sectional, descriptive self-report survey in a small northeastern state. A 7-page survey was mailed to a stratified random sample of 697 dentists, nurses, pharmacists and physicians registered in a northeastern state. The main outcome measures were demographic characteristics, lifetime, past year and past month prevalence of AOD use, the frequency of use, drug related dysfunctions, drug misuse and abuse potential. Six contacts during the summer of 2002 resulted in a 68.7% response rate (479/697). Results: Risk factors contributing to any reported past year AOD use, as well as significant (defined as the amount of AOD use by the top 25% of respondents) past year AOD use by HPs were examined using logistic regression. Risk factors of any self-reported past year AOD use included moderate or more frequency of alcohol use, being in situations when offered AODs, feeling immune to the addictive effects of drugs (pharmaceutical invincibility) and socializing with substance abusers. Risk factors of significant past year AOD use were HPs with younger licensees, a moderate pattern of alcohol use and not socializing with substance abusers. Conclusion: National and state organizations need to develop policies that focus on prevention, treatment, and rehabilitation of alcohol and other drug-using healthcare professionals. The results of this study may help to delineate the characteristics of HPs abusing drugs, leading to the development of more effective policies designed to protect the public, and move toward more tailored and effective intervention strategies for HPs.

Kintz P; Villain M; Dumestre V; Cirimele V. Evidence of addiction by anesthesiologists as documented by hair analysis. Forensic Science International 153(1): 81-84, 2005. (12 refs.)

Chemical dependency is a disease that can affect all professions. Among the health care professionals, anesthesiologists represent a specific group. Numerous factors have been proposed to explain the high incidence of drug abuse among anesthesiologists. These include: easy access to potent drugs, particularly narcotics, highly addictive potential of agents with which they are in contact, and easy diversion of these agents since only small doses will initially provide an effect desired by the abuser. Opioids are the drugs of choice for anesthesiologists, and among them fentanyl and sufentanil are the most commonly used. Alcohol is mostly abused by older anesthesiologists. Propofol, ketamine, thiopental and midazolam are also abused. In fact, all but quaternary ammonium drugs can be observed. Signs and symptoms of addiction in the hospital workplace include: unusual changes in behavior, desire to work alone, refusal of lunch relief or breaks, volunteer for extra cases, call, come in early and leave late, frequent restroom breaks, weight loss and pale skin, malpractice, behind on charts.... Toxicological investigations are difficult, as the drugs of interest are difficult to test for. In most cases, half-lives of the compounds are short, and the circulating concentrations weak. It is, therefore, necessary to develop tandem mass spectrometry procedures to satisfy the criteria of identification and quantitation. In most cases, blood and/or urine analyses are not useful to document impairment, as these specimens are collected at inadequate moments. Hair analysis appears, therefore, as the unique choice to evidence chronic exposure. Depending the length of the hair shaft, it is possible to establish an historical record, associated to the pattern of drug use, considering a growth rate of about 1 cm/month. An original procedure was developed to test for fentanyl derivatives. After decontamination with methylene chloride, drugs are extracted from the hair by liquid/liquid extraction after incubation in pH 8.4 phosphate buffer. Fentanyl derivatives are analyzed by GC-MS/MS. The following cases are included in this paper: Case 1: 50-year-old anesthetist, positive for fentanyl (644 pg/mg); Case 2: 42-year-old anesthetist, positive for fentanyl (101 pg/mg) and sufentanil (2 pg/mg); Case 3: 40-year-old anesthetist, positive for codeine (210 pg/mg), alfentanil (30 pg/mg) and midazolam (160 pg/mg); Case 4: 46-year-old nurse, found dead, positive for alfentanil (2 pg/mg) and fentanyl (8 pg/mg). In these cases, the combination of an alternative specimen (hair) and hyphenated analytical techniques (tandem mass spectrometry) appears to be a pre-requisite.

Knight JR. A 35-year-old physician with opioid dependence. (editorial). Journal of the American Medical Association 292(11): 1351-1357, 2004. (48 refs.)

This column is a case study of an impaired physician. It addresses the following questions: What is an impaired physician? Are all physicians with substance use disorders impaired? How many physicians with substance use disorders are currently practicing in the United States? Are physicians at higher risk for substance use disorders than professionals in other fields? What substances do physicians typically abuse? What should a physician do if he or she may be developing a problem with substance use? What should a colleague do if he or she suspects another physician of having a problem with substance use? When one is the primary care physician for a physician, what additional history should be obtained in an effort to screen for substance use disorders? What treatment can be offered to affected physicians, and how successful is it? When can the physician return to practice and with what restrictions? What are the job prospects for Dr L? What do you recommend for him? It covers epidemiology, screening and assessment procedures, and the role of the primary care provider.

Lloyd G. One hundred alcoholic doctors: A 21-year follow-up. (Reply). Alcohol and Alcoholism 38(2): 194-194, 2003. (0 refs.)

Long MW; Cassidy BA; Sucher M; Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. Journal of Addictive Diseases 25(1): 65-72, 2006. (13 refs.)

This project gathered survey information from physicians, physician assistants, dentists and pharmacists in Arizona who, while enrolled or following a completion of a monitored aftercare program, had relapsed back to active chemical dependency. The findings suggest several subjective factors that contributed to the subjects' relapse included (1) dishonesty to self, (2) not working a 12 step program, and (3) denial of the problem. Factors reported to be helpful for future relapse prevention were (1) abstinence from substance use, (2) working a 12 step program, and (3) having spiritual beliefs. In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college. By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Markel H. The accidental addict. (editorial). New England Journal of Medicine 352(10): 966-968, 2005. (5 refs.)

This editorial, by the director of the Center for the History of Medicine at the University of Michigan Medical School, deals with the case of William Stewart Halsted of Johns Hopkins Hospital, one of the most renown surgeons. In 1884, cocaine a derivative of tee coca plant became all the wage in medical circles. In autumn of that year Halstead who was practicing in New York City, began his own personal experiments with the "wonder drug" including its use in surgery. Within months after beginning his exploration of the drug and enlisting himself as a human subject, he had accidentally transformed himself into an addict. Two years later a friend tried to initiate an ad hoc treatment plan, which involved a several month sea voyage. Upon his return he admitted himself to a psychiatric hospital in Providence RI, under an alias. His subsequent move to the new medical school, John Hopkins is recounted, where he became the first professor of surgery, and was recognized for a number of significant innovations. There have long been questions about whether Halstead ever "conquered" his cocaine addiction. The author assembles data from diverse sources which suggest that he never did, and also provides evidence that he developed dependence on morphine.

Marshall EJ. Doctors' health and fitness to practise: Treating addicted doctors. (review). Occupational Medicine (Oxford) 58(5): 334-340, 2008. (43 refs.)

The literature describing the diagnostic process in the addicted doctor is scant. Figures from North America indicate that the prevalence of alcohol problems in doctors may be no higher than in the population as a whole, whereas high rates of prescription drug use have been recognized. This practice of self-treatment with controlled drugs is a 'unique concern' for doctors. The development of substance misuse problems in doctors cannot be reduced to a single factor: Anxiety and depression, personality problems, stress at work, family stress, bereavement, an injury or accident at work, pain and a non-specific drift into drinking have been implicated. Early diagnosis is critical because doctors are often reluctant to seek help and colleagues reluctant to intervene. Medical schools and continuing medical education programmes must give greater emphasis to addiction and substance misuse in doctors with a view to reducing the incidence of 'impaired physicians' and promoting and encouraging early treatment and rehabilitation. The relationship between the addiction psychiatrist and the occupational physician is key given that these problems occur at the interface between occupational health and regulatory systems. The need for individually tailored back to work programmes requires careful coordination and monitoring and may be difficult to implement without their involvement. Generally, the prognosis for doctors' recovery is good and it is possible to predict which doctors will 'make it'.

McAuliffe PF; Gold MS; Bajpai L; Merves ML; Frost-Pineda K; Pomm RM et al. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Medical Hypotheses 66(5): 874-882, 2006. (35 refs.)

We hypothesize that aerosolization of anesthetics administered intravenously to patients in the operating room may be an unintended source of exposure to physicians. This may lead to inadvertent sensitization, which is associated with an increased risk for developing addiction. This may contribute to the over-representation of certain specialties among physicians with addiction. We retrospectively reviewed the de-identified demographic information of all licensed physicians treated for substance abuse in the State of Florida since 1980, to determine if medical specialty was associated with addiction in this group of individuals. Then, to identify the potential for exposure, two mass spectrometry assays were developed to detect two intravenously administered drugs, fentanyl and propofol, in air. Since 1980, 7.6% of licensed Florida physicians underwent treatment for addiction. Addiction in anesthesiologists was higher than expected. Opiate abuse was greater in anesthesiologists and surgeons compared to other specialties. Aerosolized fentanyl was detected in the air of the cardiothoracic operating room, in patients' expiratory circuits, and in the headspace above sharps boxes, but not in adjoining hallways. Aerosolized propofol was detected in the expirations of a patient undergoing transurethral prostatectomy. While access and stress may place anesthesiologists and surgeons at greater risk for substance abuse, an additional risk factor may be unintended occupational exposure to addictive drugs. This report provides preliminary evidence of detection of aerosolized intravenous anesthetics using two newly developed analytical methods. We conclude that the potential exists for chronic exposure to low levels of airborne intravenously administered drugs. Further studies are under way to determine the significance of this exposure.

McBeth BD; Ankel FK; Ling LJ; Asplin BR; Mason EJ; Flottemesch TJ; McNamara RM. Substance use in emergency medicine training programs. Academic Emergency Medicine 15(1): 45-53, 2008. (38 refs.)

Objectives: To explore the prevalence of substance use among emergency medicine (EM) residents and compare to a prior study conducted in 1992. Methods: A voluntary, anonymous survey was distributed in February 2006 to EM residents nationally in the context of the national in-service examination. Data regarding 43 substances, demographics, and perceptions of personal patterns of substance use were collected. Results: A total of 133 of 134 residencies distributed the surveys (99%). The response rate was 56% of the total EM residents who took the in-service examination (2,397/4,281). The reported prevalence of most illicit drug use, including cocaine, heroin, amphetamines, and other opioids, among EM residents are low. Although residents reporting past marijuana use has declined (52.3% in 1992 to 45.0% in 2006; p < 0.001), past-year use (8.8%-11.8%; p < 0.001) and past-month use (2.5%-4.0%; p < 0.001) have increased. Alcohol use appears to be increasing, including an increase in reported daily drinkers from 3.3% to 4.9% (p < 0.001) and an increase in number of residents who indicate that their consumption of alcohol has increased during residency (from 4% to 12.6%; p < 0.001). Conclusions: Self-reported use of most street drugs remains uncommon among EM residents. Marijuana and alcohol use, however, do appear to be increasing. Educators should be aware of these trends, and this may allow them to target resources for impaired and at-risk residents.

McGovern MP; Angres DH; Shaw M; Rawal P. Gender of physicians with substance use disorders: Clinical characteristics, treatment utilization, and post-treatment functioning. Substance Use & Misuse 38(7): 993-1001, 2003. (18 refs.)

Gender has emerged as an important variable in both the course and treatment of substance-use disorders. This study examines the role of gender in a sample of physicians (n = 73) treated for substance-use disorders. Pilot data gathered on physicians treated during 1995 to 1997, included initial pretreatment characteristics, service utilization, and posttreatment functioning. Although there were many similarities, important differences emerged among the groups. These differences have implications for physician education and training and warrant more systematic clinical research.

Merenstein D. Heavy night call vs alcohol ingestion in residents. (letter). Journal of the American Medical Association 295(2): 162-162, 2006. (3 refs.)

Merlo LJ; Goldberger BA; Kolodner D; Fitzgerald K; Gold MS. Fentanyl and propofol exposure in the operating room: Sensitization hypotheses and further data. Journal of Addictive Diseases 27(3): 67-76, 2008. (50 refs.)

Inflated rates of opioid addiction among anesthesiologists may be caused by chronic exposure to low doses of aerosolized anesthetic/analgesic agents in the operating room. Such secondhand exposure produces neurobiological sensitization to the reinforcing effects of these substances, making later addiction more likely. This article extends findings that fentanyl and propofol are detectable in the air of the operating room and demonstrates that fentanyl is also detectable on surfaces in the operating room. Secondhand exposure could, therefore, occur by inhalation and skin absorption. Additionally, data show that many physicians with opiate addiction have a family history of addiction, suggesting genetic vulnerability to the effects of secondhand exposure. Other new data demonstrate that the rates of marijuana and tobacco smoking are much higher among opioid-addicted physicians, suggesting that prior exposure to THC (the psychoactive component of cannabis) or nicotine might increase vulnerability to secondhand effects. Suggestions for reducing secondhand exposure in the operating room are discussed.

Meyer JN. Chemically dependent employees and the ADA in the medical profession: Does patient safety exempt hospital employers from compliance under the direct threat and/or the business exceptions? North Dakota Law Review 80: 241-252, 2004. (97 refs.)

Summary. The Americans with Disabilities Act of 1990 (ADA) and the North Dakota Human Rights Act (NDHRA) deal with an employee's right to be protected from discriminatory employment actions based on disability, and the employer's responsibilities to a disabled employee. An employee with a chemical dependency disability presents unique problems to an employer such as a hospital, where doctors and nurses recovering from a drug addiction have access to narcotic medication and patient safety is of the highest priority. An employee with an alcohol or drug impairment must be substantially limited in a major life activity to trigger coverage under the ADA. Certainly in the case of hospitals, clinics, or other care giving facilities, a direct threat to patient safety exists when a treating nurse or physician is under the influence of drugs and/or alcohol. In dealing with a case of an impaired physicians, the court found that the employer was reasonable in termination, based on the numerous reports of alcohol odor. Ample evidence therefore existed to show that he was a direct threat to patient safety. The question, then, is whether a hospital employer must show that a particular employee with a chemical dependency disability is an actual direct threat to avoid ADA liability, or if the hospital can simply preclude such employees from certain positions based on the business necessity of safety. The author concludes that while an employer's responsibilities and an employee's rights under the ADA have been developed through case law, they are, unfortunately, still not clear regarding safety-sensitive positions and at what point the safety of a third party takes priority over accommodating an employee with a chemical dependency disability. Chemical dependency disabilities enjoy less protection than other disabilities under the ADA, and policies prohibiting such workers from safety-sensitive positions have been upheld as a business necessity in other circuits. The business necessity exemption applied in one case [Exxon], if applied more broadly, would be a more preemptive measure for employers, but would also have a more discriminatory effect on employees. Whether such an expansive policy of prohibiting all workers with chemical dependencies from treating patients would be accepted remains to be seen. Therefore, until the ADA and NDHRA are clarified through either further legislation or judicial interpretation, hospitals and employers remain in the untenable position of weighing the risk of tort liability for accidents resulting from a relapsed employee versus the risk of discrimination liability under the ADA and possibly the NDHRA.

Milling TJ. Drug and alcohol use in emergency medicine residency: An impaired resident's perspective. (editorial). Annals of Emergency Medicine 46(2): 148-151, 2005. (9 refs.)

We share the personal experience of an impaired resident who successfully completed rehabilitation and is about to graduate from an emergency medicine program and perform a brief literature review on drug and alcohol abuse in emergency medicine residencies. Residents in general are less likely than their same-age peers to abuse drugs, but a significant minority starts using drugs during residency. Emergency medicine residents have higher rates of substance use than residents in other specialties and are more likely to report current use of cocaine and marijuana.

Monahan G. Drug use/misuse among health professionals. Substance Use & Misuse 38(11/13): 1877-1881, 2003. (1 refs.)

Health professionals are among special populations in need of substance use/misuse prevention and treatment services. The behavior of impaired health professionals often have dire consequences to one's social, financial, and psychological life. This presentation outlines the epidemiology of substance use/misuse among health professionals, the consequences of the problem, and treatment issues. The work of Dr. Robert Coombs of the University of California, Los Angeles, School of Medicine and other United States and international scholars is reviewed. Cross-national policies in the field are highlighted. Unresolved critical issues are noted and discussion of needed future research.

Palhares-Alves HN; Laranjeira R; Nogueira-Martins LA. A pioneering experience in Brazil: The creation of a support network for alcohol and drug dependent physicians. A preliminary report. Revista Brasileira de Psiquiatria 29(3): 258-261, 2007. (16 refs.)

Objective: The objectives of this study are to present the creation and operation of a support network to help physicians in Brazil, describe the socio-demographic profile, and investigate the prevalence of mental disorders and chemical dependence among physicians seeking treatment. Method: Semi-structured interviews using ICD-10 criteria were conducted to obtain data regarding alcohol/drug dependence, and psychiatric comorbidity. Socio-demographic and occupational characteristics were obtained. Results: 247 patients made contact and 192 attended the first evaluation visit. Of those, 158 were male, and most (55%) were married. The mean age was 42.4 +/- 11.1 years. The reasons for seeking treatment were: comorbidity between mental disorders and chemical dependence (67.7%); chemical dependence (20.8%); mental disorders (7.8%); and burnout (4.2%). The mean interval between the detection of the problem and seeking treatment was 7.5 years. Factors associated with the severity of the problem included unemployment (21.6%), difficulties of practicing professional activities (63.5%), problems with the Regional Council of Medicine (13%), psychiatric hospital admission (31.2%), and self-medication (71.8%). In our sample, 9.3% of the physicians had changed their area of specialization. Conclusions: A high prevalence of psychiatric disorders was found in this sample as well as psychosocial and professional problems. Treatment networks focusing on the physicians' mental health could catalyze cultural changes in treatment-seeking behavior thereby improving early detection and treatment.

Peisah C; Wilhelm K. Physician don't heal thyself: a descriptive study of impaired older doctors. International Psychogeriatrics 19(5): 974-984, 2007. (27 refs.)

Background: The growing and welcome interest in the issues leading to distress and impairment in younger doctors has not been mirrored by a focus on the similar issues in older doctors which is surprising given the aging medical workforce. Objectives: To improve understanding of impairment in older doctors and to facilitate the planning of primary prevention strategies. Method: Consecutive case records of notifications to the Impaired Registrants Program of the New South Wales Medical Board, Australia, of doctors over 60 years from January 2000 to January 2006 (N = 41) were examined. Details of demographics, type of practice, nature of referral, medical morbidity, cognitive examination, psychiatric diagnosis and outcome of assessment were recorded. Results: Impaired older doctors suffered cognitive impairment (54%), substance abuse (29%) and depression (22%) and 17% had two comorbid psychiatric conditions. Twelve percent had frank dementia. Two work patterns - the "workhorse" and the "dabbler" - were observed, as was a culture of postponed retirement due to a sense of obligation and working "until you drop." Impaired older doctors were found to have higher chronic illness burden compared with community norms. Almost half were the subject of patient complaints or of poor performance within ten years of presentation. Conclusion: To our knowledge there has been no other comprehensive examination of patterns of impairment in older doctors. Older doctors are prone to suffer "the four Ds": dementia, drugs, drink and depression. We need to encourage mature doctors to adapt to age-related changes and illness and validate their right to timely and appropriate retirement.

Petersen-Crair P; Marangell L; Flack J; Harper R; Soety E; Gabbard GO. Impaired physician with complex comorbidity. American Journal of Psychiatry 160(5): 850-854, 2003. (18 refs.)

A clinical case conference is presented concerning Dr. A, a 36-year old internist who was referred to the authors for assessment, including evaluation of his ability to practice medicine. The referring physician was concerned about a personality disorder and a potential for mood disorder in addition to Dr. A's substance abuse, which had cost him his medical license in two states. Dr. A began drinking heavily at age 17, when he was having blackouts every 3-4 months during binge drinking episodes. His heavy drinking continued intermittently through college and medical school, and he was intoxicated most weekends during his residency when he was not working or on call. He entered a rehabilitation program during residency and became abstinent for about 3 years. After his residency, as a solo practitioner, he started having tension headaches, prescribed tramadol for himself, increased the dose over time to a level that caused euphoria, then decided he no longer needed to attend Alcoholics Anonymous meetings to feel good. During the next 2 years he increased his tramadol dose to a level that on one occasion caused a grand mal seizure during a minor medical procedure. He then medicated himself with primidone to prevent further seizures, continued to abuse tramadol, but remained abstinent from alcohol. He began drinking heavily when he moved to another state to take over the practice of a retiring physician and his wife had to stay behind because of work commitments. The panel's evaluations and recommendations are summarized.

Rosta J. Hazardous alcohol use among hospital doctors in Germany. Alcohol and Alcoholism 43(2): 198-203, 2008. (58 refs.)

Aims. To describe alcohol use, and the prevalence and predictors of hazardous drinking, among hospital doctors. Methods. Data were collected by anonymous mail survey in 2006, from a representative national sample of 1917 (58% response rate) hospital doctors in Germany. Alcohol use was measured using the AUDIT-C, scores of 5 or more for males and females indicating hazardous drinking. Results. There were 9.5% abstainers, 70.7% moderate drinkers, and 19.8% hazardous drinkers. The majority of doctors (90.5%) used alcohol mainly at a sensible level, e.g., 24 times a month (32%) or 23 times a week (29%), and 12 glasses on one occasion (83%). Binge drinking was common (53%), but for most occurred less than once in a month (39%). When hazardous drinking was controlled for certain confounders, being male (OR 4.7; 95% CI 3.46.5) and having a surgical specialty (OR 1.4; 1.11.8) were significantly correlated to hazardous drinking. Age had no influence on this model. By contrast, the age group 40 years and younger (OR 2.1; 1.43.0) was a significant predictor of abstinence. Conclusions. There is a higher rate of abstainers and a lower rate of binge drinkers among hospital doctors in Germany than in the general population. However, some hospital doctors drink hazardously, the risk being greater among males and among surgeons, which should be paid due attention in the interest of their health and their function as doctors.

Sebo P; Gallacchi MB; Goehring C; Kunzi B; Bovier PA. Use of tobacco and alcohol by Swiss primary care physicians: A cross-sectional survey. BMC Public Health 7(article 5), 2007. (31 refs.)

Background: Health behaviours among doctors has been suggested to be an important marker of how harmful lifestyle behaviours are perceived. In several countries, decrease in smoking among physicians was spectacular, indicating that the hazard was well known. Historical data have shown that because of their higher socio-economical status physicians take up smoking earlier. When the dangers of smoking become better known, physicians began to give up smoking at a higher rate than the general population. For alcohol consumption, the situation is quite different: prevalence is still very high among physicians and the dangers are not so well perceived. To study the situation in Switzerland, data of a national survey were analysed to determine the prevalence of smoking and alcohol drinking among primary care physicians. Methods: 2' 756 randomly selected practitioners were surveyed to assess subjective mental and physical health and their determinants, including smoking and drinking behaviours. Physicians were categorised as never smokers, current smokers and former smokers, as well as non drinkers, drinkers (AUDIT- C < 4 for women and < 5 for men) and at risk drinkers ( higher scores). Results: 1' 784 physicians (65%) responded ( men 84%, mean age 51 years). Twelve percent were current smokers and 22% former smokers. Sixty six percent were drinkers and 30% at risk drinkers. Only 4% were never smokers and non drinkers. Forty eight percent of current smokers were also at risk drinkers and 16% of at risk drinkers were also current smokers. Smoking and at risk drinking were more frequent among men, middle aged physicians and physicians living alone. When compared to a random sample of the Swiss population, primary care physicians were two to three times less likely to be active smokers (12% vs. 30%), but were more likely to be drinkers (96% vs. 78%), and twice more likely to be at risk drinkers ( 30% vs. 15%). Conclusion: The prevalence of current smokers among Swiss primary care physicians was much lower than in the general population in Switzerland, reflecting that the hazards of smoking are well known to doctors. However, the opposite was found for alcohol use, underlining the importance of making efforts in this area to increase awareness among physicians of the dangers of alcohol consumption.

Shaw MF; McGovern MP; Angres DH; Rawal P. Physicians and nurses with substance use disorders. Journal of Advanced Nursing 47(5): 561-571, 2004. (46 refs.)

Background. The literature addressing substance use patterns among medical professionals suggests that specialty, gender, age, familial substance abuse, and access/familiarity with prescription drugs are associated with particular chemical dependencies. These studies have rarely compared nurses and physicians directly, thereby making if difficult to tailor interventions to the potentially unique needs of each group. Aim. This paper reports a study to compare the initial clinical presentations, service utilization patterns, and post-treatment functioning of nurses and physicians who received services in an addiction treatment programme. Method. This exploratory study combined data collected through retrospective record reviews and prospective questionnaires. There were three types of dependent variables: initial clinical characteristics, treatment utilization patterns, and post-treatment functioning. The independent variable was membership of either professional group. Time both in treatment and between discharge and follow-up were covariates. Results. Nurses and physicians showed comparable results in most domains. Among the statistically significant differences between groups, a subset was particularly noteworthy. Prior to participating in the programme nurses showed significantly less personality disturbance than physicians, although they tended to work and live in environments with more triggers to relapse, such as other substance users. After the index hospitalization, nurses received less primary treatment, worked longer hours, and were more symptomatic than physicians. Furthermore, nurses reported more frequent and severe work-related sanctions as a consequence of their behavioural disorders. Conclusion. In most areas of study, nurses and physicians demonstrated comparable results; however, a series of statistically significant differences suggest that these groups may have unique clinical needs. The policy implications of these findings are discussed.

Smith DR; Leggat PA. An international review of tobacco smoking in the medical profession: 1974-2004. (review). BMC Public Health 7(article 115), 2007. (127 refs.)

Background: Tobacco smoking by physicians represents a contentious issue in public health, and regardless of what country it originates from, the need for accurate, historical data is paramount. As such, this article provides an international comparison of all modern literature describing the tobacco smoking habits of contemporary physicians. Methods: A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate further publications. Results: A total of 81 English-language studies published in the past 30 years met the inclusion criteria. Two distinct trends were evident. Firstly, most developed countries have shown a steady decline in physicians' smoking rates during recent years. On the other hand, physicians in some developed countries and newly-developing regions still appear to be smoking at high rates. The lowest smoking prevalence rates were consistently documented in the United States, Australia and the United Kingdom. Comparison with other health professionals suggests that fewer physicians smoke when compared to nurses, and sometimes less often than dentists. Conclusion: Overall, this review suggests that while physicians' smoking habits appear to vary from region to region, they are not uniformly low when viewed from an international perspective. It is important that smoking in the medical profession declines in future years, so that physicians can remain at the forefront of anti-smoking programs and lead the way as public health exemplars in the 21st century.

Soto RG; Rosen GP. Pediatric death: Guidelines for the grieving anesthesiologist. Journal of Clinical Anesthesia 15(4): 275-277, 2003. (12 refs.)

This essay examines the effects of unexpected pediatric death on anesthesiology house staff, and offers a discussion of normal and abnormal patterns of grieving. The increased incidence of substance abuse and suicide among anesthesiologists is discussed, and the relationship of stress following patient death and appropriate coping skills is explored. A blueprint for managing stress is given based on a military combat stress model, and recommendations for residency training programs are made.

Steiner JF. Using stories to disseminate research: The attributes of representative stories. Journal of General Internal Medicine 22(11): 1603-1607, 2007. (31 refs.)

When researchers communicate their findings to patients, clinicians, policy-makers, or media, they may find it helpful to supplement quantitative data with stories about individuals who represent themes in their research. Whether such stories are gathered during the research itself or identified from other sources, researchers must develop strategies for assessing their representativeness. This paper proposes 5 attributes of representative stories: (1) expression of important themes in the research, (2) explicit location in the "distribution" of stories that exemplify the theme, (3) verifiability, (4) acknowledgment of uncertainty, and (5) compelling narration. This paper summarizes research on substance abuse among physicians, and uses these 5 attributes to assess the representativeness of a published case report and a fictional short story about addicted physicians. While neither story is fully representative of the research, the process of evaluating these stories illustrates an approach to identifying representative stories for use in disseminating research.

Taub S; Morin K; Goldrich MS; Ray P; Benjamin R; Council Ethical Judicial Affairs. Physician health and wellness. Occupational Medicine 56(2): 77-82, 2006. (29 refs.)

Background: Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions -- usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. Objective To develop ethical guidelines regarding physician health and wellness. Methods: The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. Results: Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. Conclusions: Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.

Taylor C; Graham J; Potts H; Candy J; Richards M; Ramirez A. Impact of hospital consultants' poor mental health on patient care. British Journal of Psychiatry 190: 268-269, 2007. (5 refs.)

In a survey of 1794 UK NHS hospital consultants 1308 (73%) responded. Psychiatric morbidity (General Health Questionnaire-12 score >= 4) was present in 32% of responders, who were twice as likely to report drinking hazardous levels of alcohol, being irritable with patients and colleagues, reducing their standards of care and intending to retire early (all P < 0.001). Male and mid-aged consultants were also particularly at risk. Approaches that support consultants to practice medicine safely throughout their careers are required.

Underner M; Ingrand P; Allouch A; Laforgue AV; Migeot V; Defossez G et al. Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice. Revue des Maladies Respiratoires 23(5, Part 1): 426-429, 2006. (13 refs.)

Introduction: The aim of the study was to establish whether family physicians are influenced by their own smoking habits when issuing prevention messages to patients who smoke. Methods: 257 Family physicians of the Vienne Departement answered a survey (participation rate: 70%) investigating their own smoking habits and how they approach patients who smoke. Results: The prevalence of smoking among respondents was 26%; 30% were ex-smokers and 44% had never smoked. Regular smokers (16%) generally smoked 15 cigarettes a day and 49% were nicotine dependant - 15% highly so. When consulting, 44% of doctors stated that they systematically addressed smoking habits and 41% declared that they gave minimal smoking cessation advice. Doctors who smoke were less prone to ask their patients whether they smoke (p = 0.036) and whether they had considered quitting (p = 0.045). Unlike those who didn't smoke or had quit smoking, doctors who smoke often believed that their smoking habits had no impact on their relationship with the patients or that it might even make communication with the patient easier (p < 0.000). Conclusions: Family physicians' smoking habits have an impact on their interaction with patients who smoke. This must be taken into account in training sessions for smoking cessation.

Warhaft N. The Victorian Doctors Health Program: The first 3 years. Medical Journal of Australia 181(7): 376+, 2004. (10 refs.)

The Victorian Doctors Health Program (VDHP) was established in November 2000 to provide a confidential and compassionate service for doctors and medical students with health concerns, including alcohol, other drug and mental health problems. Although funded by the Medical Practitioners Board of Victoria, the VDHP is completely independent of the Board. Its staff include a director with experience of North American Physician Health Programs and a case manager/psychologist. In its first 3 years of operation, the VDHP had 438 contacts: 218 requests for advice and information, and 220 contacts resulting in provision of services (to 92 doctors and students with alcohol or other drug problems, 82 with psychiatric problems, and 40 with stress-related or emotional problems). 99 participants received standard care (assessment, referral and up to two consultations with the program) and 56 extended care (three or more consultations with the program). 65 participants (most with substance use disorder) entered the more intensive Case Management, Aftercare and Monitoring Program (CAMP); 57 of these have had outcomes considered satisfactory, with 50 returned to work.

Wilhelm KA; Reid AM. Critical decision points in the management of impaired doctors: The New South Wales Medical Board program. Medical Journal of Australia 181(7): 372-375, 2004. (14 refs.)

The New South Wales Medical Board has developed the Impaired Registrants Program to deal with impaired registrants (doctors and medical students) in a constructive and non-disciplinary manner; the program is now well established. The Program enables the Board to protect the public, while maintaining doctors in practice whenever possible. Disorders that commonly lead to referral of impaired doctors include alcohol and drug misuse, major depression, bipolar disorder, cognitive impairment and, less commonly, psychotic and personality disorders and anorexia nervosa. Pathways in the program are individualised according to the impact of the specific disorder, the registrant's career stage, stage of involvement in the program, insight and motivation. Critical points in the program include entry, easing of conditions, breach of conditions, return to work after suspension, and exit from the program. Decision-making at these points takes into account the nature of the impairment, compliance, professional and personal support available and the registrant's insight and motivation.

Wunsch MJ; Knisely JS; Cropsey KL; Campbell ED; Schnoll SH. Women physicians and addiction. Journal of Addictive Diseases 26(2): 35-43, 2007. (21 refs.)

Nine hundred and sixty-nine impaired physicians (125 women and 844 men) enrolled in one of four state physician health programs were evaluated with comprehensive psychosocial, psychiatric and substance abuse/dependence profiles. When compared to male impaired physicians at time of entry to physician health programs, the 125 female impaired physicians were younger (39.9 vs. 43.7 years; p < .0001), reported more medical (48.7% vs. 34.4%; OR = 1.81) and psychiatric (76.5% vs. 63.9%; OR = 1.84) problems at intake. They were more likely to report past (51.8% vs. 29.9%; OR = 2.51) or current (11.4% vs. 4.8%; OR = 2.54) suicidal ideation, and more likely to have made a suicide attempt under the influence (20.0% vs. 5.1%; OR = 4.64) or not under the influence (14.0% vs. 1.7%; OR = 9.67) of a substance. Although alcohol was the primary drug of abuse for all physicians studied, women physicians were more likely to abuse sedative hypnotics than men (11.4 vs. 6.4; OR = 1.87). There were no gender differences in employment problems (65.3% vs. 67.5%; ns) or legal problems (15% vs. 21%; OR = .66) due to addiction. These findings suggest different characteristics between male and female impaired physicians which may have implications for identification and treatment of this population.